Agency Works to Draw Down Costs, Maintain Top Medical Care

Army Spc. Ahndrea Alattar, a radiology technologist assigned to the 47th Combat Support Hospital, 62nd Medical Brigade, simulated imaging a soldier’s neck during a field training exercise on Joint Base Lewis-McChord, Wash., Sept. 20, 2013. Throughout the week, the unit operated out of their 44-bed Early Entry Hospital Element to treat real patients for sick call and surgery as well as mock patients for a simulated massive casualty situation. (U.S. Army photo by Sgt. Sarah/Released)

The Defense Department’s goal to save medical dollars and deliver the best health care possible has made strides in its first 100 days, the director of the new Defense Health Agency said.

Air Force Lt. Gen. (Dr.) Douglas J. Robb said the agency — which stood up Oct. 1 in Fairfax, Va. — has been on a “journey” to make the military health care system more viable.

A concept that has been studied 17 times since 1942 resulted in DHA after defense leaders three years ago organized a task force to look at how to make military medicine more efficient, more effective and more affordable, Robb explained.

As an agency of the umbrella Military Health System organization, DHA manages three major cost-saving areas for Army, Navy and Air Force medicine: standardized medical practices, six “multiservice markets,” and 10 of the military services’ health-related functions, called “shared services,” such as health information technology and the TRICARE health plan network.

“We looked at the next five years, which is expected to save $2 billion in [just] the 10 shared services,” Robb said, adding that DHA already has saved DoD money in its first three months.

Avoiding redundancy creates immediate savings, Robb said, which is “extremely important in the tight fiscal environment we’re in today.” Military treatment center leaders are “driven” to save money to build a better military health system, he added. Standardization in medical care, which cuts waste and duplication, is another critical element in cost-saving goals for all three services, the general said.

Even as it works to get the most out of available dollars, DHA’s priority is its medical readiness mission and quality medical care in a deployed environment, Robb said.

“What 10 to 12 years of conflict has taught us is we can deliver incredibly efficient and high-quality health care in combat,” he said. “We did that through a joint effort, practicing side by side in a deployed environment in Iraq and Afghanistan. We were able to deliver joint [service] and coalition health care that’s never been seen in the history of conflict.”

As a result of that teamwork, he said, military medical standards stem from the “best practices” extracted from all the services’ procedures used in wartime medicine and surgery. That data, he added, was then put in the hands of the “best and the brightest” people from across the services to compile.

Combat trauma care from point of injury to surgery and hospital recovery is an example of best medical practices, the general said.

“We’ve changed the way America does trauma care delivery,” Robb said. “The beauty of our system is that we have not just active duty, but Guard and Reserve [medical personnel] who take back the best practices to [the hospitals where they work in civilian life] and change the way they do business there.”

And critical to medical professionals maintaining their skills in addition to cutting health care costs is to “recapture patients back into our direct-care system,” Robb explained. Caring for patients in military medical treatment facilities can be done less expensively compared to civilian contract care, he noted. “But what’s more important is the more patients we see, the more we bring … the tough cases to our large medical centers,” he added. “That drives up our competency, so it makes a better professional environment [to allow medical personnel] to practice medicine in a deployed environment.”

In the meantime, Robb said, “as we wind back down from 12 years of conflict, we get a more stable, professional medical population that will be able to serve our beneficiaries.”

Military medicine during the war effort had “incredible focus,” he said, and as a result, the lowest disease and death rates in the history of warfare. “We’re going to use that same focus on garrison-based care,” he added.

DHA oversees six multiservice areas to handle the largest DoD populations of its 9.7 million beneficiaries — service members, families and veterans, Robb said. The multiservice areas are the Tidewater area of Virginia, the national capital region; Colorado Springs, Colo.; San Antonio; the Puget Sound area of Washington; and Hawaii.

“Those [markets] comprise about 45 percent of our direct-care costs -– what we spend on our health care delivery inside our medical treatment facilities,” Robb noted. Historically, he said, the most populated areas of beneficiaries have medical care available from more than one of the services. In Colorado Springs, for example, the Army and Air Force each have hospitals and several bases.

In what Robb called a fundamental change, DHA’s multiservice areas will share a single existing hospital and a joint-service staff, Robb explained.

“It won’t be the Army, Navy or the Air Force by itself,” he said. “The services will work to bring those resources [together] to better serve the market through decreased redundancy, increased standardization, [with] better outcomes [and] better quality.”

Using joint staffs in a single hospital is a growing concept across the country, he noted, adding that such systems exist between a few military hospitals and Veterans Affairs Department medical professionals who “embed” in military hospitals.

“It makes sense on several counts,” Robb said. “The VA looks for access and DoD is looking for opportunities for the ‘tougher cases.’”

The third critical cost-saving piece of DHA is its management of 10 “shared services,” which now comprises all three services’ TRICARE contracts, pharmacy operations, medical facility planning, medical logistics and information technology. In about six months, the agency also will manage all three services’ medical education and training, research and development, acquisition and contracting, budgeting and resourcing, and public health, Robb confirmed.

In a shared system of the services’ TRICARE contract network, patients won’t see a lot of change under DHA, he said.

“From a patient’s perspective, it should be transparent,” Robb explained. “TRICARE is not going to change. What [patients] will see in the future is a more integrated system between our military treatment facilities working side by side with our TRICARE network.”

When DHA makes decisions in the direct care system and how it affects referrals or the TRICARE contracts, he said, DHA officials will look at the effects on the direct care system. “That is going to be vetted as we get the most efficient and effective health care system in our U.S. military,” he added.

The 10 shared services are just a beginning, because more joint functions will be added as the agency grows, Robb said, noting that some of the Defense Centers of Excellence functions are being considered for DHA management.

“DHA will be an organization in transition for a long, long, time,” Robb said. “I envision that DHA, with its modest beginnings today, will look a lot different in 25 or 30 years.” He cited decades of evolution in the Defense Logistics Agency as an example.

“What we’ve never had before in the Military Health System is a central organization where we can bring these efforts together,” Robb said, adding that he’s already receiving feedback from senior leaders inside and outside DOD who commend DHA as a single point of contact in the Military Health System.

By cutting waste and redundancy among the three medical services, providing top-quality care at less-expensive costs and fine-tuning medical readiness, DHA has a vital future in DOD, the general said.

“It enables the surgeons general to provide a military health care system that has a medically ready force,” he added, “and a ready medical force for their service chiefs and combatant commanders.”

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